Basic Information
| Provider Information | |||||||||
| NPI: | 1134266810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEN | ||||||||
| FirstName: | LUKE | ||||||||
| MiddleName: | YU-PING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8109 FREDERICKSBURG RD | ||||||||
| Address2: | PHYSICIAN PRACTICE SERVICES | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754837 | ||||||||
| FaxNumber: | 2105758647 | ||||||||
| Practice Location | |||||||||
| Address1: | 8201 EWING HALSELL DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754837 | ||||||||
| FaxNumber: | 2105758647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | N4090 | TX | Y | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | N4090 | TX | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8CD428 | 01 | TX | BCBS | OTHER | 207073202 | 01 | TX | CSN | OTHER | 207073201 | 05 | TX | MEDICAID |